Men's accounts of erectile function over time following radical prostatectomy: A narrative study.

Background: Prostate cancer requiring radical prostatectomy surgery, invariably affects many aspects of men's lives. Whilst altered sexual function is well documented as a potential outcome of surgery, the impact on men's lives over time is little understood. Objective: This study explored men's accounts of erectile dysfunction over three distinct time points: pre-operatively (n = 13), three months post operatively (n = 10) and six to nine months post operatively (n = 11). Design: Narrative Inquiry. Settings: A large tertiary teaching hospital in Dublin, Ireland. Participants: The first participant was recruited in August 2019. 18 men participated in a total of 34 interviews over three different time points. Methods: Narratives were examined individually initially then collectively to ascertain the elements of the unfolding story over time. Structural and thematic analysis comprised the analytic framework for the study. Results: Men's accounts of erectile dysfunction were inextricably linked with masculine identity and subscription to masculine norms and accounts varied over time. Pre-operatively - men actively minimised erectile function over survivorship. This perspective changed in the two post-operative periods (most notably at 3 months) where men began voicing retrospective misunderstanding of the extent of their erectile dysfunction as well as regret and struggle with interventions aimed at optimisation of erectile function. Cost issues appeared to be challenging for men accessing care for penile rehabilitation. Throughout all narrative time points, age, fatherhood, relationship status and gender were identified as narrative rationalising strategies in their life stories including interaction/communications with healthcare professionals. Humour and metaphor assisted men's expressions of this intimate, life altering experience. Conclusions: Men's information and service needs relating to erectile dysfunction post radical prostatectomy vary over time. This highly masculinised experience of erectile dysfunction requires nurses to provide gender sensitive care pathways and survivorship care in a format which aligns both to men's gender identity (and cost limitations) and is sequenced appropriately. Use of humour may be useful in assisting men's engagement with information and care interventions. Clearer explanation of the impact of surgery pre-operatively including (clear distinction between erectile dysfunction and fatherhood at the point of diagnosis) as well as careful attention to men's evolving understanding regarding erectile dysfunction would prove useful for effective survivorship.